Background

Colorectal cancer (CRC) is a common and lethal disease; it remains the third most frequently occurring cancer among both genders. In Egypt, colon cancer represents the ninth most common cancer while rectal cancer ranks the 18th most common cancer by incidence. The application of cancer stem cells (CSC) as prognostic markers in CRC is now studied, among which is CD44, which is implicated in cellular growth, differentiation, survival as well as the metastatic behavior of cancer cells. The prognostic role of CD44 in CRC is still controversial. The study aims at inspecting CD44 immunoreactivity in the epithelium of colorectal cancer specimens and to detect its association with the patients’ clinicopathological features as well as its prognostic significance.

Methods

This retrospective cross-sectional study included 85 CRC specimens and 16 adenoma specimens collected from the Pathology Department, South Egypt Cancer Institute, during the period from 2018 to 2020. All specimens were stained by anti-CD44 antibody.

Results

CD44 epithelial expression in colon cancer tissue specimens was substantially higher than in normal mucosa. It was observed that 95% (n = 81) of the studied colorectal carcinoma cases showed positive CD44 epithelial expression compared to distant normal mucosa as controls as well as adenoma cases where only 43.8% (n = 7) of adenoma cases showed positivity with highly significant p-value P = 0.000 and it correlates with cancer progression and aggressiveness. Low H score expression H ≤ 150 had better 3 years disease-free survival DFS estimated by 83.3% compared to 79.6% with high H score expression with significant P-value (P = 0.041).

Discussion

Our current study showed a statistically significant association between CD44 expression and tumor size (T), lymph node metastasis (N) as well as disease stage with P-values (P = 0.009), (p = 0.000) and (p = 0.000), respectively. CD44 epithelial immunostaining showed to be of an adverse prognostic significance in early CRC associated with more aggressive behavior and worse survival.